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Case of the Week #320
A 30 year old man presented with phimosis. A white plaque lesion was noted on his glans penis, measuring 0.7 x 0.6 cm in size, which was biopsied.
What is your diagnosis?
Balanitis xerotica obliterans
Discussion: Balanitis xerotica obliterans, also known as lichen sclerosus of genitalia, is the male equivalent of lichen sclerosus et atrophicus of the vulva, a chronic and atrophic mucocutaneous condition. It is the most common cause of pathological phimosis in boys, and may also cause narrowing of the urethral meatus and paraphimosis. It also affects middle-aged men.
Clinically, it presents as a gray-white, irregular geographic foci of atrophy in the inner foreskin, glans or perimeatal area, with variable erosion, ulceration and raised pearly white areas. Microscopy shows a thinning or thickening of epidermis with orthokeratotic hyperkeratosis. There is also lamina propria thickening and loss of structures due to edema, sclerosis or hyalinization. The basal layer shows vacuolar degeneration, accompanied by diffuse fibrosis and a deep lymphocytic infiltrate. Atypical cases may have epithelial changes of penile intraepithelial neoplasia (PeIN), usually differentiated.